Saturday, January 14, 2017

Week 2: Back to Square One

The end of a year and the beginning of another is typically a time for contemplation and new beginnings. Two years ago, I wrote a long and heartfelt post about gestational diabetes being a wake up call for me, and resolved to make some positive changes in my life in 2015. And indeed, 2015 was a year of hard work and many lifestyle changes. I put many new habits into place and gratifyingly, becoming lighter, fitter, stronger as the months went by.

And then, things changed again. By the end of 2015, I was pregnant with my second baby and the first trimester fatigue was overwhelming. I had to take life one day at a time. My history of gestational diabetes flagged me for an early screening test, the one-hour glucose tolerance test. I failed the test by a small margin, with my blood glucose measuring at 144 mg/dL when the cut-off is 140 mg/dL. This meant that I had to go in for the three hour 100 gram glucose tolerance test. My glucose measured perfectly within-range for the longer test, so my OBs and I collectively breathed a sigh of relief and they advised me to keep doing what I was doing in terms of being active and moderating my carb intake.

Around 25 weeks is when most pregnant women in the US are tested for gestational diabetes, and when this time rolled around for me, it was recommended that I go in for yet another three hour glucose tolerance test. And I did something that I rarely do in the face of medical advice- I refused to take the test. Why? Because (a) I am "borderline" on these tests, either narrowly passing them or narrowly failing them more or less depending on the day, (b) I find this test to be extremely unpleasant what with drinking 100 grams pure glucose on a fasting stomach and then sitting around the lab for 4 hours for 4 separate needle sticks, and (c) most importantly, if I failed the test, the next step would simply be that I would be testing myself 4 times a day with finger-sticks and a glucose meter and controlling my blood glucose with diet and exercise.

So I chose to skip the test, and go straight to the self-monitoring. I had my glucose meter from 5 years ago; I bought fresh test strips and new batteries, re-calibrated the meter and was good to go- testing 4 times a day (fasting + an hour after breakfast, lunch and dinner) and meticulously recording the numbers. Interestingly, two of my OBs thought my approach was perfectly reasonable. The third OB was not happy- her argument was that without the test, I don't have a diagnosis of being either positive or negative for gestational diabetes- having the diagnosis flags a woman for further tests. I saw her point and worked out a negotiation- I would continue self-monitoring and let them know if the numbers were trending high (but still skip the darn glucose tolerance test). And she would send me for a late-term ultrasound, which they recommend for GD+ women to make sure the baby wasn't getting too big (etc.)

I find glucose self-monitoring is the most amazing tool for me. You get instant feedback on how you are doing and how different types, amounts and combinations of foods affect your blood glucose. For instance, my numbers would always run high after eating Chinese take-out, even when I skipped the rice. They would run high when I ate take-out pizza, even if I ate only 2 small slices and a big salad on the side. The finger-pricks honestly are not painful, especially once you learn how to do them right, but I still find them unpleasant to do. There are a few non-invasive glucose monitors being developed- skin patches, earlobe clips- and I hope they are commercially available soon because I want to buy and use one of these. Regular glucose monitoring is the best way to prevent and self-manage diabetes.

Anyway, I managed to keep the glucose numbers within range during the pregnancy. After a few weeks of within-range numbers, one of the OBs said I could calm the heck down and test only 1 day or so per week. Even though last spring and summer was a hectic time for our family and there was no time for carefully calibrating diet and exercise, I believe that the reason it went better this time was because I was in better health at baseline and knew what works for my body. I will be eternally grateful that the baby was born uneventfully and with an average birthweight.

With a new baby, all kinds of routines and habits go down the tubes. We have been in maintenance mode. Now with a nearly 6 month old baby, I feel as though I am back to square one in some ways. And that is OK. I just have to work out a new normal in terms of eating and exercising. In life, the only constant is change and you just keep adapting and tweaking the routine to keep up.

So when this past weekend, a dear friend brought up the idea of doing a sugar-free month, I jumped up and said I would do it with her. She was inspired by this NYTimes article. The sugar-free month is intended to reset taste buds that have been over-indulging in sweets over the holiday season. It is a way to become more aware of how much sugar we consume on a day to day basis without even realizing it.

We're trying to get some of our friends and co-workers to join in on the "fun". The whole month of February will be our sugar-free month so we have a couple of weeks to prepare for it. When I say sugar-free, it is more of a "free of added sugars", meaning that sugars naturally occurring in fruits, vegetables and dairy are fine. But really, each person doing the challenge gets to make their own rules about what foods they want to cut out and what habits they want to change.

Do you have any interest in joining our Sugar-Free February challenge? Let me know and I will post updates on the blog so we can all do it together.

56 comments:

Your post reminded me of my own finger pricking sessions during pregnancy. I wasn't diagnosed with GD, but given the then health statuses and carrying twins, meant that I was put on it as a given. I didn't have to do it too long though (which I would have gladly done alternatively) since they were born at 24 weeks. With that outcome and dealing with two newborns and their issues, health and diet for me kind of went out of the window. My kids will be turning 2 soon, and as thankful as I am for them surviving and some!, feel this is a good time to get my life back on track. If not for me, then definitely for them. So, I guess this is my long winded way of saying 'Yes! I would love to join in on the challenge.' :) - Neha

OH goodness Neha! 24 weeks. What a journey you and your twins have been on, and how wonderful that they are doing well. Big hugs to you all.

I'm with you on the "if not for me, then definitely for them deal", because it takes a lot of energy to run after these kids, and it takes a lot of self-control to be a good role model. I have tried steering my daughter towards fruit while sneaking cheetos from the pantry and believe me it did not work ;)

Thank you for your kind words, Nupur. It's an ongoing process with various therapies in the works but the outcomes have always been good. I'll give a shout out for PT, OT and ST here. I've seen it's wonders first hand, and would encourage anyone and everyone, if ever in doubt, to consider it, and to spread the word. - Neha

What you say is so true. My kids watch goes in my mouth like hawks! They may not want it if served to them, but if I put it in my mouth, they sure do want it!

Neha- Thanks for your note. It is very heartening to know that your twins are being helped by these awesome professionals. You must be so busy running after these two tots :)

I find the easiest way to create interest in a new food is to sit down and eat it myself with relish, soon enough a little voice pipes up and asks me for a bite! Apparently food tastes better when eaten out of a parent's plate.

Hi, nice information. I read the NYTimes article that you have given. After going through that I can confidently say that probably our authentic Indian food (breakfast, lunch or dinner) is really healthy and balanced, balanced for each region too.. like different for coastal areas, dry lands etc.

Perhaps you mean that hidden sugars are more of an issue in processed food and not in made-from scratch food? I agree with that. But I will say that lots and lots of people who eat a traditional Indian diet are sick with diabetes, it points to the fact that South Asians are genetically predisposed to diabetes but our diet tends to be carb-heavy.

Exactly. Even a so-called vegetarian Indian diet may not exactly be a "healthy" one, if it is loaded with carbs. Even in a typical thali that comprises of dal, rice/roti and a sabzi, I have seen that people tend to eat more rice/roti than dal or sabzi.

Right- and rice/roti are more affordable fillers where dal and sabzi are more expensive, so I understand why people have the habit of eating more of one and less of the other. Also, the higher carb meals were fine at a time when people did much more manual labor, walked everywhere, when housework was heavy physical labor. But times have changes and habits have not.

Would you mind sharing what the cutoff levels were for fasting and 1hr post meals? My OB has me check 2 hrs post the start of meals and the target ranges are 90 for fasting and 120 for 2hr post. I wonder if 1hr post is better and more informative. I had the Chinese food reaction as well since the sauces are loaded with sugar. I'd love to join the challenge. Thanks, Nupur!

Fasting is 90, yes, and 1 hour post-meal is 140. In my perhaps simplistic way of thinking, 1 hour post meal helps you see the sugar spike (if any) that the food causes, and 2 hours post meal is more of how your body is able to handle that spike. I think if possible doing both gives the best information but if I had to choose one, I'd do the 1 hour. Good luck! Glad you want to join the challenge.

Kudos to you for refusing! I was vainly trying to convince my OB that I would not do the GTT as the syrup that they give is full of checmicals and I was not subjecting my baby to do that, especially sine I was eating clean my whole pregnancy. Although she agreed with me, she said they did not have any alternatives and I gave in. I would love to see your updates on the sugar free month. I am never brave to try any sort of diet. I eat everything in moderation and have been able to lose 15 baby pounds this way. I am back to my pre (first) baby weight (although I reminded myself that losing weight deoes not mean gaining fitness!). It is triply hard with two kids but I am sure you will your pattern.

Sangeetha- Good for you for taking the slow and steady route and doing things by moderation! Yes, one does have to find a new pattern with a new baby in the mix.

Incidentally, none of the chemicals in the GTT syrup bothered me much- it was not my reason for refusing it. I've read those blog posts making alarmist claims about the syrup and to me, it is much ado about nothing. It is the test itself (and yes, that bolus of glucose on a fasting stomach can certainly make one dizzy and sick to the stomach), and the fact that I preferred to monitor my glucose regardless of the test result.

Sounds like a great way to cut back on the sugar but as it is a big birthday month for us I don't think I could stick at it - but will be interested to see how you go. I am in admiration of the finger pricking as I don't like blood or needles much! (Not that I am a fan of the fasting/drinking glucose either)

Count me in please! I'm all for no-sugar foods. And count my husband in too!

I do have something to say and please feel free to delete my comment if you find it inappropriate. It's an earnest request to everyone to please not ignore your GTT during pregnancy. The reason I say this is about 30 years back, my mother had diabetes during pregnancy, which obviously went unnoticed since there was no testing those days. This led to my brother to have cerebral palsy due to neonatal hypoglycemia after birth. He's still mentally and physically challenged. You can imagine how hard my parents life must be. Could have been avoided easily.

Given our family history, my gynecologist and nutritionist put me on a very very strict diet after my 2 hour GTT came out 119. It's well within range but we were all too afraid to take chances. No insulin for me thankfully, but a diet so strict it would put movie star's meal plan to shame. Of course, it paid off in the form of a lovely healthy baby boy and a normal delivery but those last 3 months were hard!

I hope you didn't think that my post advocated skipping a potentially life-saving test! What I did was that I proceeded as if the test had been a positive- and monitored myself closely for gestational diabetes. So I am completely with you- in saying that gestational diabetes is a serious issue, and one should be take it seriously. I don't like the current diagnostic test for it but that's neither here nor there.

I am indeed very sorry about your brother. That is a tough situation. Diabetes is such a horrible disease in so many ways. And honestly that's why I spend so much time on my blog harping about it, trying to understand it, and figure out how we can eat in ways that prevent it without being on too restrictive a diet.

So glad things worked out well in your pregnancy! It is hard to be on a diet while still eating well enough to nourish the baby.

No no, please don't misunderstand. That was not directed at you. It was a general request to women to please monitor their glucose levels so as to avoid any potential problems with the baby.

I do have a hypothetical question though. Since you skipped the test, how would you have known if your glucose level was very high? What if you needed insulin? Is that something you'd have known just by testing yourself?

I tested my glucose 4 times a day, every day, (right when I woke up, and after 3 meals), and that's how I would have known if my glucose level was very high. I was monitoring myself closely.

If I had seen numbers that are out of the expected range, then the next step would have been to control carbs even more and see if the numbers came down, and if not, then the next step would have been insulin.

The placenta produces insulin-blocking hormones; that's normal and it happens in every pregnancy. Most women cope with that by producing extra insulin in pregnancy, but some can't produce enough extra insulin and they develop GD. In some GD+ women, controlling carbs can be enough to manage it because that reduces your need for insulin, but in other GD+ women, it is not enough and they need injected insulin. In my first pregnancy, my GD was controlled comfortably with diet and exercise, and the second time around, the glucose numbers stayed within the normal range.

Hi Nupur,i was diagnosed with GD when i was pregnant with my daughter. your post brought back memories of the 4 pricks a day to monitor my glucose levels. Luckily i could control the diet and my baby was born normally with average birth weight. She is almost 15 months old now. Though i hardly gained any weight during the pregnancy, I am itching to get back in shape. Having a full time job, managing home and a very active toddler means that i find it difficult to get time for myself(or maybe i just need to plan things better :-)) I would love to try the sugar-free month!Kejal

Good plan! My husband began this as a New Year 2016 resolution (no added sweeteners), and he has been successful sticking with it till date. But he doesn't have a sweet tooth, and we hardly eat any processed food - so it hasn't been a challenge. However, this year's resolution (his) is "no fried foods." Now that may be a toughie because he loves chaat.:)

What a great proactive way of addressing GD. I feel like every Indian I've met - skinny or not , young or older , have all hadGD. So unfortunate. Our food , vegetarian especially is truly carb heavy. I've had type II diabetes for 10 yrs so both my kids were born under the condition. Lots of finger pricks both times. I was in great shape with my first pregnancy and I managed my condition really well. For my second one (btw both my kids are the same age as yours !) I found it very hard to keep good control while juggling my son his school and full time work. While I wasn't perfect I did my best and have a beautiful healthy (a bit chubby ) 6 month old daughter now. In hind sight I should've done better with my diet and scaled back work to take care of myself. I'm trying very hard to minimize carbs in my diet but must say I am suffering from food addiction. I do well one day and poorly the next. But I keep going back and starting over everyday. Try cutting out carbs - ie less than 50 gms of carbs per day. It makes a huge difference in how you feel. And you blood sugar levels. Let's hope I can be carb free and be able to reverse my condition over the next few months. If I follow my diet sincerely , I will automatically be sugar free in Feb (and March let's hope). Looking forward to your updates.

Archana- Yes, we are all doing our best, and living with type II diabetes must only complicate your already busy life! I wish you the very best as you continue to tweak your diet to reverse your diabetes. I too am trying to think of a way to devise a low-moderate carb diet for myself that I can stick to for life. Going carb free is not an option for me; I eat a vegetarian diet and all plant foods have carbs. But within the limits of what I am willing to eat, there is a lot that can be done to cut extra carbs and do it in a way that is sustainable and enjoyable for life. Let's support each other, we are all in this together! Oh, and congrats on the sweet baby girl :)

Hi Nupur,Your discipline and commitment to staying healthy is admirable. I noticed one thing in your post--you spoke of high glucose levels after eating takeout Chinese & pizza--did you eat similar homemade items and repeat the test? I'm curious whether homemade fast food would have a similar effect.

Hi Aarti- Yes, I have tested my glucose numerous times after eating homemade meals of veggie stir-fry, fried rice and such, and flatbread pizzas (I haven't made pizza dough at home in years), and my glucose levels are within range. I personally find it MUCH easier to keep glucose levels normal with homemade fast food, even when I cook lavishly with sauces, cheese etc. It may be because take-out is loaded with even more hidden sugar (ie, in savory foods) than we imagine, or that is so delicious and tempting that I find it hard to control portions...but yes, home cooking becomes even more important when managing diabetes or gestational diabetes.

Thanks for sharing, Nupur. I don't have children, but I do have a busy schedule, so your experience reaffirms the idea that the effort and time taken to put homemade food on the table everyday is well worth it.

Nupur, I am rooting for you :). I am not disciplined like you and others to take up this challenge. I am hopelessly addicted to coffee and I cannot imagine having it sugarless. But I am hopeful to get motivation from your experience. Good luck

Hai Nupur - After a decade hoped back to blog ,first and foremost your name and blog came to my mind,I still remember Dale how is he?just peeped in ,belated wishes for mother of a boy and a girl..Happy New year !!!!!

You have managed your GD so well. I guess the second time was easier ( well, not easier, but with prior experience, I guess you were better prepared). I had GD too and managed it well on diet. Just that I totally neglected myself later.

I would like to join the team here. I have this habit of not caring what I eat when I'm alone, on most days I just eat whatever is easy ( meaning carbs) and cook a good dinner when the family is together.

I need to pull my act together, I'm at risk for diabetes , so many reasons, hereditary, my age and weight, my food habits... I've started having my cup of tea without sugar ( feels like an enormous sacrifice, but it's a start) cut out rice from my diet . I'll pick pointers here and hopefully it will be a lifestyle change.

Hi Nupur, I rarely comment, do regularly follow. But it is amazing to know that you were able to an extent even prevent GD. coming from a family with strong history of diabetes, this is a good information to have.

Hi Sachita- Yes, I was very relieved to be able to control GD much better this time around. I will say that cutting carbs is not enough for some women to prevent GD (because there are so many factors involved, not all within our control) but for many, a carb-controlled diet with regular glucose monitoring works wonders.

Hi Teju, I can tell you what's worked for me- (a) Instead of rotis, I eat low carb tortillas. (b) I drastically reduce the amount of rice and fill the plate with salads and cooked vegetables instead. Basically, I fill myself up with dal and veggies.

This may or may not appeal to you but just try different things to find something that works! Good luck!

Hi Teju,I too am a vegetarian, and was looking for other options to incorporate in our meals. About an year ago, I started cooking a quarter cup of quinoa along with a cup of rice. That was a small change, which also resulted in all of us consuming less rice from then on. It is good idea to fill up our plates on veges and dal, as Nupur has mentioned. I follow this practice mostly, but do cheat every now and then. :)

Hi Nupur,I already tried a version 1.0 of going sugarless in November and realized is a bit challenging when you read labels of all the food items you eat. Cutting out processed foods eliminates lot of choices and cravings kick in and that is when the mind over the body/tongue takes over. I did it purely to see how much control I have over my desires. I am going to give it another shot in February with my previous experience in tow. Looking forward to it. RegardsR2D2

Hi Nupur, I don't think so sugar is the enemy here. Putting 1 teaspoon of sugar in chai is not the culprit. exercise along with proper diet will prevent diabetes. it takes sometime but denying yourself of your chai is not something I would do.I like this blog here which explains why sugar is not evil - http://rujutadiwekar.blogspot.in/2017/01/the-case-for-sugar.html

Pallavi- Agreed that the 1 tsp of sugar in chai is not the culprit. What becomes a problem is when the sugar and simple carbs add up little by little all through the day and the sum total is too much for one's body to handle. For a metabolic disorder like diabetes, diet is overwhelmingly important- exercise has its place but diet is what makes or breaks it. "Proper" diet is exactly what I am trying to put in place here, trying to figure out how little or how much rice/sugar and such foods I can safely eat while maintaining glucose control.

I don't think I am denying myself of anything; simply trying to change my habits for the better. We all find different ways to do this!